Proposed Rule Outlines Navigator Standards

The Centers for Medicare and
Medicaid Services (CMS) released a proposed rule
yesterday outlining standards that "navigators" in federally facilitated
and state partnership exchanges, also known as marketplaces, must meet.

Navigators are entities or
individuals that will provide accurate and unbiased information to consumers
about the exchanges, qualified health plans, and public programs including
Medicaid and the Children's Health Insurance Program. For those who are not
familiar with health insurance, have limited English literacy, or are living
with disabilities, navigators will help ensure that they understand their
health coverage options.

The proposed standards would help
ensure that navigators and other assistance personnel will be fair and
impartial and will be appropriately trained, and that they will provide
services and information in a manner that is accessible.

CMS also proposes 2 amendments to
the existing regulation for navigators that would apply to all navigators in exchanges,
clarifying that any navigator licensing, certification, or other standards
prescribed by the state or exchange must not prevent the application of the
provisions in the Affordable Care Act. The proposal also seeks to make entities
with relationships to issuers of stop loss insurance (policies that protect
companies against
catastrophic claims) ineligible to become navigators, including those who are compensated directly or indirectly by
issuers of stop loss insurance in connection with enrollment in qualified
health plans or non-qualified health plans. The same ineligibility criteria
that apply to navigators would also apply to non-navigator assistance personnel
providing services in any federally-facilitated exchanges, including in state
consumer partnership exchanges, and to federally funded non-navigator
assistance personnel in state-based exchanges.

In addition to navigators, consumers
will have access to assistance through services such as a call center, which
will be operated by the Department of Health and Human Services, for obtaining
referrals to the appropriate state or federal agencies, in-person assistance
personnel, certified application counselors, and agents and brokers.